Mental Health Services Act

Mental Health Services Mental Health Services ActAct

Mental Health Provider Mental Health Provider MeetingMeeting

February 18, 2005February 18, 2005

Presented byPresented byNancy Peña, Ph.D., DirectorNancy Peña, Ph.D., Director

Santa Clara County Mental HealthSanta Clara County Mental Health

Meeting ObjectivesMeeting Objectives

To Review MHSATo Review MHSA

To Orient Providers to MHSA To Orient Providers to MHSA Planning ProcessPlanning Process

To Obtain Contract Provider Input To Obtain Contract Provider Input and Commitment to Client and and Commitment to Client and Family Engagement Strategies Family Engagement Strategies

The OpportunityThe Opportunity

Social Analysts have revealed Social Analysts have revealed flaws in the current system, flaws in the current system, providing objective evidence of providing objective evidence of the negative individual, social, the negative individual, social, and financial outcomes that are and financial outcomes that are resulting from neglect of the resulting from neglect of the mental health of our citizens mental health of our citizens


Local systems are stretched beyond Local systems are stretched beyond capacity and unable to meet demandcapacity and unable to meet demand

Administrators are distracted by the Administrators are distracted by the burdens of bureaucracy and financial burdens of bureaucracy and financial crisis and uncertainty crisis and uncertainty

Clinical leaders are preoccupied with Clinical leaders are preoccupied with operational demands and are unable operational demands and are unable to focus on effective quality to focus on effective quality improvement efforts that insure improvement efforts that insure excellence in practice and optimal excellence in practice and optimal client outcomes.client outcomes.


Consumers and family members are Consumers and family members are without adequate care and are demanding without adequate care and are demanding that mental health be addressed with the that mental health be addressed with the same urgency as health caresame urgency as health care

They are demanding freedom from They are demanding freedom from stigma, a path to recovery and wellness, stigma, a path to recovery and wellness, excellence in service, and inclusion as excellence in service, and inclusion as partners in their own care and in the partners in their own care and in the service delivery system service delivery system


Advocates and Stakeholders have Advocates and Stakeholders have presented the issues to Californians presented the issues to Californians and have offered a compelling set of and have offered a compelling set of strategies to correct the current strategies to correct the current system flaws.system flaws.

Citizens have affirmed the reality of Citizens have affirmed the reality of the current crisis, and have mandated the current crisis, and have mandated solutions to be financed and solutions to be financed and implemented.implemented.

Providing System Providing System Stakeholders a Stakeholders a Window of Opportunity Window of Opportunity to Maketo MakeFar-Reaching Change Far-Reaching Change

The ChallengeThe Challenge

Mental Health Directors and Mental Health Directors and Provider Leaders Need to step Up Provider Leaders Need to step Up and Provide Leadership in this and Provide Leadership in this Exciting New Era in Public Mental Exciting New Era in Public Mental Health History….Health History….

The VisionThe Vision

Is not created or facilitated by Is not created or facilitated by legislation or moneylegislation or money

Is created by LeadersIs created by Leaders

◆ in clarity and soundness of ideasin clarity and soundness of ideas◆ in effectiveness of in effectiveness of

communicationcommunication◆ in influence and engagementin influence and engagement◆ in sustained purpose and actionin sustained purpose and action


DMH: “To… expend funds made available through this initiative to transform the current mental health system in California …This will not be “business as usual”. Eventually access will be easier, services more effective and out-of-home and institutional care will be reduced.”


Outlines Transformation Outlines Transformation AreasAreas:: Consumer and Family Participation

and Involvement

Programs and Services

Community Partnerships

Cultural Competence

Outcomes and Accountability


Consumer and Family Involvement

Increased participation in all aspects of the system

Increased Consumer Operated Services

Full participation in Treatment Planning


Programs and ServicesPrograms and Services

Increased geographic access

Incorporation of best practices

Increased array and choice of service


Programs and Services Improved Services for

Transition Age Youth

Integrated screening, assessment and treatment

for co- occurring disorders

Improved services to 0-5


Community Partnerships

Increased participation and collaboration among a wide variety of agencies and services


Cultural CompetencyOutreach and expansion of services Outreach and expansion of services

to underserved ethnic communitiesto underserved ethnic communities

Implementation of more culturally Implementation of more culturally and linguistically competent and linguistically competent assessments and services aligned assessments and services aligned with culture, race, ethnicity, age, with culture, race, ethnicity, age, gender, sexual orientation and gender, sexual orientation and religious/spiritual beliefsreligious/spiritual beliefs


Outcomes and Accountability

Expanded commitment to monitoring of consumer and system outcomes

Incorporation of outcomes data into part of program planning

The ProcessThe Process

Santa Clara County -

Broad based stakeholder process

Stakeholder Leadership Committee to:

Review Development of PlanReview Development of Plan Facilitate Stakeholder InvolvementFacilitate Stakeholder Involvement Educate CommunityEducate Community Advise Board of SupervisorsAdvise Board of Supervisors

Board of Supervisors

State Dept. ofMental Health

BOS Committees(HHC, CSFC, PSJC)

County ExecutiveSCVHHS Exec. Dir

MHSA StakeholderLeadership Committee

Data, Technology,

Budget Work Group

Prevention & Early

InterventionWork Group

Children’s System of Care Work

Work Group

Adult/Older Adult

System of Care Work Group

Community Stakeholder Forums, Focus Groups, and Consumer Engagement Groups

Cultural Competency Readiness Forums Recovery/Self Help Readiness Forums

FocusGroup

FocusGroup

FocusGroup

FocusGroup

FocusGroup

Accountability Commission

Mental Health Board

Project Management

Team

Santa Clara CountyMHSA Planning

Structure

The ProcessThe Process

Monthly Stakeholder Leadership Monthly Stakeholder Leadership Meetings for:Meetings for:

Information and Status ReportsInformation and Status Reports Input from Broad CommunityInput from Broad Community Readiness ForumsReadiness Forums

Work Group Meetings:Work Group Meetings: Child, Adolescent, Young Adult SOCChild, Adolescent, Young Adult SOC Adult and Older Adult SOCAdult and Older Adult SOC Prevention and Early InterventionPrevention and Early Intervention Data, Infrastructure and Human ResourcesData, Infrastructure and Human Resources

Regular Reports Board and Board Regular Reports Board and Board Committees and Mental Health BoardCommittees and Mental Health Board

The Process - Santa Clara County The Process - Santa Clara County Partial List of StakeholdersPartial List of Stakeholders

Mental Health Department (chair)Mental Health Department (chair) County Executive’s Office (co-chair)County Executive’s Office (co-chair) Mental Health Board (co-chair)Mental Health Board (co-chair) Mental Health Self-Help Centers Mental Health Self-Help Centers MHD Office of Consumer MHD Office of Consumer

Empowerment Empowerment National Alliance for the Mentally Ill National Alliance for the Mentally Ill Association of Mental Health Association of Mental Health

Contractors Contractors Non-AMHCA mental health providersNon-AMHCA mental health providers Labor OrganizationsLabor Organizations Foster Care Association Foster Care Association Residential & Group Home ProvidersResidential & Group Home Providers Parents Helping Parents Parents Helping Parents Department of Alcohol and Drug Department of Alcohol and Drug

Services Services Public Health Department Public Health Department VMC Acute Psychiatric Services VMC Acute Psychiatric Services Custody Health ServicesCustody Health Services Valley Medical Center Valley Medical Center Office of the Public GuardianOffice of the Public Guardian

Police Chief Association Police Chief Association SCC Sheriff SCC Sheriff Department of Social Services Department of Social Services Probation Department Probation Department Superior Court Superior Court District Attorney’s Office District Attorney’s Office Public Defender’s Office Public Defender’s Office County Office of Education County Office of Education School District Superintendents School District Superintendents First Five Commission First Five Commission Council on Aging Council on Aging Office of Affordable Housing Office of Affordable Housing Domestic Violence Council Domestic Violence Council School Linked Services School Linked Services United Way United Way Interfaith Council Interfaith Council Silicon Valley Council of Non-Silicon Valley Council of Non-

profitsprofits San Andreas Regional CenterSan Andreas Regional Center

The Process – Phase IThe Process – Phase I

Engagement and CommitmentEngagement and Commitment Invite Stakeholder InvolvementInvite Stakeholder Involvement

Share Intent and VisionShare Intent and Vision

Set Tone of Inclusion Set Tone of Inclusion

Establish Collective Receptivity Establish Collective Receptivity

Align Expectations Without Align Expectations Without Losing Losing Optimism Optimism

Outline Planning LandscapeOutline Planning Landscape

The Process – Phase II The Process – Phase II

Learning and AssessmentLearning and Assessment Learn Current Service Delivery SystemLearn Current Service Delivery System

Learn Needs and Interests of Learn Needs and Interests of Consumers, Consumers, Family Members, Family Members, Providers, System Providers, System Partners, Partners, Community – (left and right Community – (left and right brain brain approaches)approaches)

Learn Best Practice Strategies to Meet Learn Best Practice Strategies to Meet NeedsNeeds

Learn Outcomes & Accountability Models

The Process – Phase IIIThe Process – Phase III

Prioritization and Planning Establish Local Mission, Values & Establish Local Mission, Values &

Transformation ObjectivesTransformation Objectives

Prioritize Local NeedsPrioritize Local Needs

Select Effective Strategies to Meet Local Select Effective Strategies to Meet Local NeedsNeeds

Complete Planning ComponentsComplete Planning Components

The Process – Phase IVThe Process – Phase IV

Implementation

Obtain State Approval & FundingObtain State Approval & Funding

Select Local ProvidersSelect Local Providers

Establish Local Accountability Establish Local Accountability StructureStructure

Initiate and Monitor ServicesInitiate and Monitor Services

Evaluate ServicesEvaluate Services

The Process – Lifespan The Process – Lifespan FrameworkFramework

Determine and Prioritize Local Determine and Prioritize Local Mental Health Needs Across Mental Health Needs Across LifespanLifespan

Prevention

Early Intervention

Intervention

All Citizens Across Lifespan

Citizens in need

Unmet Need

Current Public MH System


Children, Youth Children, Youth and Young Adultsand Young Adults

0 - 5 years0 - 5 years

6 - 11 years6 - 11 years

12 – 17 years12 – 17 years

18 – 25 years18 – 25 years

Adults and Older Adults and Older AdultsAdults

26 – 35 years26 – 35 years

36 – 50 years36 – 50 years

51 – 65 years51 – 65 years

65 + years65 + years

• Population SizePopulation Size

• Geographic DistributionGeographic Distribution

• Ethnicity and ImmigrationEthnicity and Immigration

• Gender Gender

• AgeAge

• Service UtilizationService Utilization

• Prevalence InfoPrevalence Info

• Risk & Special PopulationsRisk & Special Populations

• Unmet NeedUnmet Need

• Stakeholder InputStakeholder Input

For Each Developmental Group Describe:Developmental Group Describe:


For Each Developmental Group For Each Developmental Group Assess Each Transformation Area:

Consumer & Family Involvement

Community Partners

Programs & Services

Cultural Competency

Accountability and Outcomes

Where Are We?

Assess Strengths & Weaknesses in each area

Where Do We Want to Be?

Determine Transformation Objectives in each area


Early Intervention


Developmental Group

Strategies to Transform Current System

Strategies to Increase Services

Strategies forEarly Intervention & Prevention

Prevention

Intervention

For All Ages

The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:

Establish Formal Interagency Policy Establish Formal Interagency Policy ForumsForums

Establish System Goals for All AgesEstablish System Goals for All Ages

Assure Consumer & Family Influence Assure Consumer & Family Influence and Involvement at all levels and Involvement at all levels

Outline System Values and Outline System Values and PhilosophyPhilosophy

The Impact on County The Impact on County Service SystemsService SystemsPressure to:Pressure to:

Determine and Prioritize Consumer Determine and Prioritize Consumer NeedsNeeds

Implement effective culturally Implement effective culturally competent prevention, early competent prevention, early intervention and treatment servicesintervention and treatment services

Demonstrate process quality and Demonstrate process quality and favorable outcomesfavorable outcomes

The Impact on County The Impact on County Service SystemsService Systems

Affirm System Values and Affirm System Values and PhilosophyPhilosophy Access and Choice

Cultural Proficiency

Early Identification

Family-Driven

Collaborative

Individualized Plans

Community Based

Strengths Based


Local System – Establish Local System – Establish Common Goals for All AgesCommon Goals for All Ages

Health & Well

Being

Stability in Family & Social

Relations

Success in School/Wor

k Meaningful

Activity

Safe From Harming or

Being Harmed in Community

Examples of System Outcome ObjectivesHealth

Insurance

Health Visits

Health Status

Suicide

Stable Living

# Placements

DV Incidents

School Attendance

Graduations

Work stability

CJ Recidivism

Days incarcerated

Victims of Crime

CJS Diversions


Establish System Structure Establish System Structure and Stakeholder Involvementand Stakeholder Involvement

Individual & Family

Provider Services

System Policy and

Management

Sta

keh

old

ers

System Performance: Expectations & Results

Provider Performance: Expectations & Results

Client Level Outcomes: Expectations & Results


Demonstrate process quality Demonstrate process quality and favorable outcomesand favorable outcomes

Who Do We Serve?

What Are We Trying to Change?

What Practices Do We Employ and Why?

How Do We Insure Quality of Practices?

How Do We Measure Results?

What Results Do We Achieve?

The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to EngagePressure to Engage To Become Involved as StakeholdersTo Become Involved as Stakeholders

To Educate and Inform Your Boards, To Educate and Inform Your Boards, Staff and Families, and Business Staff and Families, and Business PartnersPartners

To Actively Involve Your Consumers To Actively Involve Your Consumers and Familiesand Families

To Actively Partner With System To Actively Partner With System Players in Your CountyPlayers in Your County

The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to Learn and AssessPressure to Learn and Assess Understand Stakeholder ViewsUnderstand Stakeholder Views

Know the System and CommunityKnow the System and Community

Understand Consumer Opinions and Understand Consumer Opinions and Needs Needs

Learn Most Effective Strategies and Learn Most Effective Strategies and Competencies that Meet NeedsCompetencies that Meet Needs

Assess Agency Strengths and Assess Agency Strengths and Weaknesses Relative to Weaknesses Relative to Transformation ExpectationsTransformation Expectations

The Impact on The Impact on Individual Service Individual Service ProvidersProviders Pressure to Prioritize and PlanPressure to Prioritize and Plan

Revisit Mission and Business Objectives Revisit Mission and Business Objectives

Affirm Practice Philosophy, Values and Affirm Practice Philosophy, Values and ProcessProcess

Outline Cultural Competency Objectives Outline Cultural Competency Objectives

Articulate Process Standards and Articulate Process Standards and Outcome Expectations and Track ResultsOutcome Expectations and Track Results

Determine Infrastructure Needs to Determine Infrastructure Needs to Maintain Process Standards and Achieve Maintain Process Standards and Achieve OutcomesOutcomes

The Impact on The Impact on Individual Service Individual Service ProvidersProviders

Pressure to Implement ChangesPressure to Implement Changes

Establish Consumer & Family Establish Consumer & Family PartnershipsPartnerships

Restructure care planning process Restructure care planning process

Implement Cultural Competency Implement Cultural Competency InitiativesInitiatives

Implement Process Improvement Implement Process Improvement StrategiesStrategies

Evaluate & Report Service OutcomesEvaluate & Report Service Outcomes

Consumer and Family Consumer and Family EngagementEngagement

Goal:Goal: To bring the voice of To bring the voice of 5,000 consumers and family 5,000 consumers and family members into the processmembers into the process

How: Focus Groups Meetings Surveys Other?

Community Community EngagementEngagement

Goal: To bring the voice of 5,000 To bring the voice of 5,000 community members, including community members, including unserved and underserved unserved and underserved communities to the process.communities to the process.

How: Focus Groups Meetings Surveys Other?

Provider Provider CommitmentCommitment

How Will You Involve How Will You Involve Consumers?Consumers?

What Resources Will What Resources Will it it Take?Take?

Documents

Mental Health Services Act